Asthma

Selecting a Treatment Regimen Refer to Table 5 for Inhaled Corticosteroids (most potent and first-line anti-inflammatory therapy) Generic ( Table 4. Long-Term Control Medications ) Dosage Form Methylprednisolone (Medrol® ) Prednisolone (Prelone® Prednisone (Deltasone® IgG1k ) , Flo-Pred® ) Omalizumab (Xolair® ) 5 mg tablets; 5 mg/5 mL, 15 mg/5 mL syrup 2.5, 5, 10, 20, 50 mg tablets 1 mg/mL solution 150 mg in 1.2 mL/vial (aſter reconstitution with 1.4 mL sterile water for SC injection) 2, 4, 8, 16, 32 mg tablets Dose Systemic corticosteroids (reserved for severe asthma and not controlled with other medications, for acute and moderate to severe exacerbations, and to speed recovery from and prevent recurrence of exacerbations) 5-60 mg daily in single AM dose or qod prn for control Short "burst" to achieve control: 40-60 mg/d as single or 2 divided doses for 3-10 d monoclonal antibody/IgE blocker (for moderate to severe persistent asthma with symptoms inadequately controlled by inhaled corticosteroids and with reactivity to perennial aeroallergen) 150 or 375 mg SC q4wk, or 225, 300, or 375 mg SC q2wk; doses/frequency determined by pretreatment serum IgE (IU/mL) and body weight (kg); Max 150 mg per injection site Long-acting β2-agonists† (alternative to increasing doses of, or as adjunct to, low to moderate or higher doses of inhaled corticosteroids. Used with, not in place of, anti-inflammatory agents, especially for nocturnal symptoms or to prevent exercise-induced bronchospasm) Albuterol (VoSpire ER® 4-8 mg tablets ) Formoterol† (Foradil Aerolizer® Salmeterol† (Serevent Diskus® Montelukast (Singulair® ) Zafirlukast (Accolate® ) Zileuton (Zyflo CR® Cromolyn (Intal® ) Theophylline (Slo-Phyllin® Theo-24® Uniphyl® , Theolair® , others) , , ) Effective inhaled alternative to short-acting β2 safety is the primary advantage) -agonists for exercise-induced symptoms (margin of MDI: 800 mcg/puff NEBULIZER: 20 mg/2 mL ampule Liquids, sustained release tablets, capsules 2-4 puffs tid-qid (10-15 min before exercise) 1 ampule tid-qid Methylxanthines (alternative third-line agent) Serum monitoring is important. Maintain serum concentrations of 5-15 mcg/mL at steady state. Starting dose for children and adults > 45 kg: 300-600 mg/day qd for 3 days; then 400-600 mg qd. Alair® Bronchial Thermoplasty System™ * Recently FDA-approved for severe asthma in poorly controlled patients ≥ 18 years, this device is passed through a bronchoscope to deliver heat to reduce excessive smooth muscle in the airway, limiting its ability to constrict during an asthma attack. (*Not addressed in the NAEPP 2007 guidelines.) †BLACK BOX WARNING: Long-acting β2 should never be used alone in children or adults with asthma. Please see product labeling for information on this warning. An FDA Medication Guide should be distributed to patients starting a new prescription. -adrenergic agonists may increase the risk of asthma-related death. They 5 ) Leukotriene modifiers (alternative to increasing doses of, or as adjunct to, moderate or higher doses of inhaled corticosteroids) 10 mg tablet 4, 5 mg chewable tablets 4 mg oral granules packet 10, 20 mg tablet 600 mg tablet 6-14 yr: 5 mg chewable tablet qhs > 14 yr: 10 mg tablet qhs 40 mg/d (20 mg bid) 1 h before or 2 h aſter meals 1200 mg bid ) DPI: 12 mcg/single use capsule 1 capsule q12h DPI: 50 mcg/blister 1 blister q12h 4-8 mg q12h; Max dose: 32 mg/day Br and

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